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NPI Code Detail

MEDICARE: BRUCE WAYNE PARKER O.D.

MEDICARE: BRUCE WAYNE PARKER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOR 1450TOR
2152W00000XOptometristWA OD 00001253WA

General Provider Information

NPI Number : 1679586168
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE WAYNE PARKER O.D.
Provider Business Mailing Address
First Line : 3460 N HOLLY ST
Second Line :
City : CANBY
State : OR
Zip : 97013-8136
Country : US
Telephone Number : 503-266-6355
Fax Number :
Provider Business Practice Location Address
First Line : 19500 SE STARK ST
Second Line : ROCKWOO MEDICAL OFFICE
City : PORTLAND
State : OR
Zip : 97233-5757
Country : US
Telephone Number : 503-669-3900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 07/08/2007

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Directions to “ BRUCE WAYNE PARKER O.D.” Practice Location

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